Hi JH,
Ok looking at the symptoms first
Your scored 24 on the hypogoandal checklist that was created by Dr Malcolm Carruthers- one of the world leading andrologists.
About that result he says the following
Hypogonadal Rating
0-9 Unlikely, 10-19 Possible, 20-29 Likely, 30-39 Very Likely, 40+ Severe
Dr Malcolm Carruthers, says about this checklist on page 49 of his book The Testosterone Revolution (quote verbatim).
This will help determine with a fair degree of probability whether you or a friend or a partner are andropausal (a sometimes expressed term to mean hypogonadal), although only assessment by a doctor experienced in this field and a full hormonal profile will confirm or exclude the diagnosis.
So based on the symptoms Dr Carruthers would think you would be likely to have hypogonadism based upon symptoms.
Now let’s look at the bloods and use them as a guide in conjunction with the symptoms.
Your LH level is higher than what is typically seen even though it is probably in range (you didn’t supply that information for your specific test).
Your total testosterone level looks fine. However this is not the key factor in assessing androgen status.
I notice that your free testosterone whilst being within the normal range (normal range- see Shippen comment I put in my large posting on problems with reference ranges) is very low in the range.
When I see a low normal free testosterone test and symptoms that suggest definite but less severe hypogonadal symptoms, these marry well and suggest to me that there is a problem of sorts regarding testosterone/androgen deficiency.
When I find something like that, I like to find something that indicates whether the problem is likely to be primary (testicular), secondary (hypothalamic/pituitary) or metabolic (a form of a secondary problem) in origin.
I have noted your somewhat elevated LH, but this alone does not make me think eureka.
What does make me sit up (not quite eureka) we “MIGHT” have it! Or at least part of the problem;
Is when I see a very high normal level of SHBG like 45nmol/l (the reference range takes into account men who are 90 years old etc- that is important to remember- being in the range does not equate to intrinsic well being and this is where good analysis is important).
Now you have the really great news and the really bad news.
I’ll start with the really great news;
I think your pituitary is to some degree asking your testicles to produce more testosterone, hence the slightly elevated LH. I think they cannot do that because they are probably working at full natural output in your case. They are producing a fairly reasonable level of testosterone at 17nmol/l.
I think the reason your pituitary is not too happy with the level of testosterone is that your SHBG has bound most of that reasonable total testosterone level. As such you are now left you with a low normal free testosterone level that is not high enough for you to adequately function on.
So I think your problem is unlikely to be primary/testicular in origin.
I doubt the problem is one of a basic hypothalamic-pituitary/secondary affair based on the LH and SHBG.
I think that Propecia has left you with an elevated level of SHBG and consequently a lowered level of free testosterone and resulting moderate hypogonadal symptoms.
I think there is a reasonable chance that if you lowered your SHBG level you would see a pleasing rise in your free testosterone and consequently a relief of some or all of your symptoms.
The bad news;
We do not know if you also have a problem with DHT or not or with estradiol, because we have not got test results for these important hormones. It is possible that lowering SHBG alone will not help you if these hormones are out.
It is also quite difficult to A) find an endocrinologist or andrologist that understands what metabolic secondary hypogonadism is, B) the only medication that I know that is supposed to work in lowering SHBG that I have seen success with has been Danazol (something that may or may not work for you and might be hard to obtain in any case).
More good news;
Given your symptoms and pathology it is possible, possible being the operative word that if you can get a top andrologist who understands these matters- possible that Danazol alone will do the trick. It might just get you back to normal. Unquestionably if I were in your shoes with this SHBG issue;
Good endo+Danazol would be what I would work towards along with testing of estradiol and DHT next time out.
Thoughts?
P.S
This is a NOT supposed to replace or represent the feelings of a doctor but a basic layman’s evaluation. You would need to forward such matters with a top andrologist/endocrinologist and see how things pan out. I hope this information can really help along the way even if it is not an endocrine investigation. There certainly can be more to your situation- but I think I have highlighted certain important points.